Provider Demographics
NPI:1114963170
Name:RULLAN, PETER P (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:P
Last Name:RULLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 LANDIS AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-2650
Mailing Address - Country:US
Mailing Address - Phone:619-426-9600
Mailing Address - Fax:619-426-4112
Practice Address - Street 1:256 LANDIS AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2650
Practice Address - Country:US
Practice Address - Phone:619-426-9600
Practice Address - Fax:619-426-4112
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42243207N00000X, 207ND0101X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ73699ZMedicaid
CAA89753Medicare UPIN
CAZZZ73699ZMedicaid